Document J3ydZ4B785x3XJEyKEwEYKOZX
INTERNAL CORRESPONDENCE
TOs Ms. Maureen Kelly CBPD - B3 Danbury Office
CC: File
UC 14*- 2
l. O. BOX 471, TEXAS CITY. TEXAS 77 590
DATE: December 6, 1983 RE: T. P. Kingsbury SS#234-24-9903
The spouse of the subject retiree notified me that deducts for health coverage code SI are still being taken from his pension check. The correct health coverage code is 01 effective 10-1-83 (see attached).
Please handle this matter and reimburse Mr. Kingsbury for money due.
NTH:ar Attachment
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Nancy T. HalsVead Benefits & Records Chief
PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE
ORDER"
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INTERNAL, correspondence
ue u*- i
O. SOX 471, TEXAS CITY, TEXAS 77S90
TO: Ms. Maureen Kelly CBPD B3 Danbury Office
CC: --7-tm Fill RAVES File
DATE: November 11, 1983
RE: T. P. Kingsbury SS0 234-24-9903
Please change health coverage code from SI to 01 effective 10-1-83, for the subject retiree. Mr. Kingsbury has notified me to drop his sponsored dependent. This change supercedes all previous changes submitted for this retiree.
yjhanks, (J\OAU^
N. T. Halstead Benefits & Records Chief Employee Relations Department
NTH:ar
PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE
ORDER"
|JCC 059353
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INTERMEDIATES
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. the employee.ieelready aarotifc^l&ft-hfce Basle Plan.
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} ' Request for refund of Contributory Retirement Plan.
=Z3 Affidavit of lost Retirement Plait Certificate.
Request to vest Retirement Plan Contributions.
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Management Representative
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Copies routed to:
Plant Extens ion
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Enq>loyee (Gold Copy) jf^r^
Employee File (Pink Copy)
! I Tickle File Copy (Yellow Copy)
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PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE
ORDER"
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COMPLETE THIS FORM BY TYPEWRITER OR BALL POINT PEN RETURN FORM TO YOUR LOCAL MANAGEMENT REPRESENTATIVE WHO WILL FORWARD ENTIRE SET TO EPAD FOR PElOCESSLiG
GROUP INSURANCE
Metropolitan Life Insurance Cumi-anv
BENEFICIARY DESIGNATION
:i
(Before Completing Form See Rcvertc Side)
Group Policy Numbers 12200-0. I22G1-G. 161M-G, 22970-G, 23I88-G
,, Date of
Soc. Sec.
Paypoint.......515................Birth..........1/13/23......... Number.. 224.-24-9903..
NAME: Thomas P. Kingsbury
MAIL ADDRESS: 2905 Houston Drive TO La Marque, Texas 77563
PLEASE PRINT
4
; !I - I I revoke any prior designations and designate with respect to the above
policies under which I currently am or may become insured, the following:
50%
Thelma 0. Kingsbury Name....
Wife
--A,ge........6..5.......
(Relationship)
2905 Address.
Houston
Drive,
La
Marque,
Texas
77568
Mary Suzanne Rodie Name.... 1/3 of 5Q>.
Daughter
(Relationship)
Age................
Gary Kingsbury Name.... 1/3 of 50% Address.
JoLynn Kingsbury Name.... 1/3 of 50% Address.
Son
(Relationship)
Age..............
Daughter -Age.................
(Relation ship)
In equal shares, or all to the survivors in equal shares, or all to the last survivor.
I reserve the right, at any time, to change this designation.
Date.
G. 20 U.C.C.--12200 <2-71) minted in u.s.
*"* (Signature of Insured) EPAD COPY
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PRIVILEGED AND "CONFIDENTIAL MATERIAL SUBJECT TO PROTECTIVE
ORDER"
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Death Claim File cc: Plant Manager
D. C. Heyen
L. M. Barr T. B. Shannon
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GENERAL INFORMATION SHEET ON
DEATH OF EMPLOYEE OR RETIREE
Active Employee Retiree | y` j
1|
Regular r~ |
T&P | x
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Name
p ^ng.hnry________________ P/R# 02536
S.S. # 234-24-9903
Add2r90e5 HsousstonODricve cNourth pa~ tio..n. Stores0_ Clerk
,
La Maraue. Texas
77568______ Birth Date 1-13-23 Last Day Worked 2-7-83
Date of Death 12-30-83
Term
Date
9-1-83
C.S.D. 2-18-53
C.S.C. 30 Years
Benefit Plans: Metropolitan Life $ 58,Q00
SupplementalXXXX $ 29,000
Pension Plan$ Savings Plan Vacation
Beneficiary 50% - Thelma Kingsbury
Beneficiary 50% - Thelma Kingsbury 1/3 Each Gary Kingsbury (son)
mSSXXiUHa&m Mary Suzanne Rodie (daug) JoLynn Kingsbury (daug)
SS0 Elected lYesI NAME Thelma Kingsbury (wife)
Beneficiary
Bene ficiary
Credit Union: | j No Account !___| Prime Account with a Joint-Member 1 j Prime Account in a Single Name Other:
Name
PRIVILEGED AND "CONFIDENTIAL MATERIAL
SUBJECT TO PROTECTIVE ORDER"
Survivor(s) : Address:
Thelma Kingsbury (wife)
JoLynn Kingsbury (daug) Marv Suzanne Rodie (daue) Jeanine Light (step-daug) Gayy Klngghnry fson') ....
3 Sisters & CranHphilHren
Letter to Spouse/Survivor Mailed 1-3-34
Funeral Arrangements:Services were held at 2 PM on 1-2-84 at James Crowder Funeral Home Chapel. Burial followed at Grace Memorial Park in Hitchcock, Texas.
Flowers Sent: Floral Spray Florist: Colonial Flower Shoppe Amount: $30.00
Prepared by
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-STATE OF TEXAS
GALVESTON COUNTY HEALTH DISTRICT
I HERESY CERTIFY THAT THE ABOVE IS A TRUE AND CORRECT COPY OF THE CERTIFICATE AS RECORDED IN THE GALVESTON . ------COUNTY HEALTH DISTRICT, GALVESTON, TEXAS.
PRIVILEGED AND "CONFIDENTIAL MATERIAL
SUBJECT TO PROTECTIVE ORDER"
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